CONCLUSION: Contrary to common opinion that SWL is the least invasive therapy, the reported stress parameters did not show significant differences between SWL, RIRS, and MIP, although significantly bigger stones were treated with MIP.

I would not agree to the authors conclusion that: ”changes in IL-6 and CRP levels showed no significant difference between SWL, RIRS, and MIP.” The post procedural rise was up to2 fold after SWL and RIRS but 6-7 fold after MIP. The authors fail to explain why SWL patients had elevated pre- and post procedural CRP levels.

This paper closes a small gap in our knowledge about the changes of acute phase parameters like IL 6 and CRP after urological procedures.
We already knew that ESWL had no influence (Reference 15: Fornara P, Doehn C, Seyfarth M, Jocham D. Why is urological laparoscopy minimally invasive? Eur Urol 2000;37: 241–250.) and that MiniPNL or PNL had a small impact on these parameters ( Reference 28 and 29: 28. Aghamir SM, Mojtahedzadeh M, Meysamie A, et al. Comparison of systemic stress responses between percutaneous nephrolithotomy (PCNL) and open nephrolithotomy. J Endourol 2008;22:2495–2500. 29. Li LY, Gao X, Yang M, et al. Does a smaller tract in percutaneous nephrolithotomy contribute to less invasiveness? A prospective comparative study. Urology 2010;75:56–61) .
Now we know that RIRS also has no effect.
I would not agree to the authors conclusion that: ”changes in IL-6 and CRP levels showed no significant difference between SWL, RIRS, and MIP.” The post procedural rise was up to2 fold after SWL and RIRS but 6-7 fold after MIP. The authors fail to explain why SWL patients had elevated pre- and post procedural CRP levels.
Peter Alken